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Para-aortic lymph node sampling in pancreatic head adenocarcinoma.
- Source :
-
The British journal of surgery [Br J Surg] 2014 Apr; Vol. 101 (5), pp. 530-8. - Publication Year :
- 2014
-
Abstract
- Background: The significance of positive para-aortic nodes in patients with resectable pancreatic carcinoma is unclear. This study sought to evaluate the accuracy of intraoperative detection and prognostic significance of these lymph nodes in patients with resected adenocarcinoma of the pancreatic head.<br />Methods: From 2000 to 2010, para-aortic node sampling was performed prospectively in all patients before pancreatoduodenectomy. Frozen sections were created and nodes categorized as positive or negative for metastases. Surgeons were blinded to the frozen-section results. This was followed by standard histopathological assessment of corresponding paraffin-embedded, haematoxylin and eosin-stained material. Nodes considered uninvolved by this analysis were examined immunohistochemically for micrometastases.<br />Results: A total of 111 consecutive patients were included, with a median follow-up of 20·8 (range 1·5-126) months. The 1-, 2- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 73·6, 54·0 and 24·7 per cent, and 51·8, 28·1 and 18·8 per cent respectively. Para-aortic node involvement was always associated with peripancreatic lymph node metastasis, and was detected by frozen-section analysis in 12 patients and by haematoxylin and eosin staining in 17. Sensitivity and specificity of frozen-section examination for detecting para-aortic lymph node metastases were 71 and 100 per cent respectively. Median OS for patients with and without para-aortic node involvement on frozen-section analysis was 9·7 versus 28·5 months respectively (P = 0·012), and 15·7 versus 27·2 months (P = 0·050) when assessed by haematoxylin and eosin staining. Median DFS for patients with and without para-aortic node involvement on frozen-section examination was 5·6 versus 12·9 months respectively (P = 0·041), and 8·4 versus 12·9 months (P = 0·038) for haematoxylin and eosin analysis. The presence of micrometastases in para-aortic nodes was not significantly associated with altered OS or DFS.<br />Conclusion: Para-aortic node sampling with frozen-section examination detects distant lymphatic involvement reliably. It should be performed systematically. When metastases are found, they should be considered a contraindication to pancreatic resection.<br /> (© 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.)
- Subjects :
- Adenocarcinoma mortality
Adenocarcinoma surgery
Aged
Aorta, Abdominal
Disease-Free Survival
Female
Frozen Sections
Humans
Intraoperative Care methods
Intraoperative Care mortality
Lymph Node Excision methods
Lymph Node Excision mortality
Lymphatic Metastasis
Male
Neoplasm Recurrence, Local mortality
Neoplasm Recurrence, Local pathology
Pancreas
Pancreatic Neoplasms mortality
Pancreatic Neoplasms surgery
Pancreaticoduodenectomy methods
Pancreaticoduodenectomy mortality
Prognosis
Prospective Studies
Sensitivity and Specificity
Adenocarcinoma pathology
Lymph Nodes pathology
Pancreatic Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2168
- Volume :
- 101
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The British journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24633831
- Full Text :
- https://doi.org/10.1002/bjs.9444